Eating Disorders and Trauma: Understanding the Connection
Eating disorders are about food—but they're rarely only about food.
For some people, eating disorder behaviors become intertwined with experiences of trauma, safety, control, emotion, relationships, or the body itself.
That doesn't mean everyone with an eating disorder has experienced trauma. It also doesn't mean trauma automatically causes an eating disorder.
But when the two occur together, understanding their relationship can be an important part of treatment.
How Can Trauma and Eating Disorders Be Connected?
Trauma can affect the way someone experiences their body, emotions, relationships, and sense of safety.
Eating disorder behaviors may sometimes develop or intensify as a way of managing experiences that feel overwhelming.
Restriction may create a sense of control or emotional numbness.
Binge eating may temporarily provide comfort or relief.
Purging or other compensatory behaviors may become ways of managing distress.
Changes to the body may also carry complicated meanings related to safety, visibility, identity, or experiences someone has had in the past.
None of this means that someone consciously chooses an eating disorder as a coping strategy.
These patterns often develop gradually.
A behavior that initially seems to help someone manage distress can eventually become a source of significant distress itself.
Sometimes the Eating Disorder Feels Safer Than Recovery
From the outside, it can be difficult to understand why someone would feel afraid to give up something causing them so much pain.
But if an eating disorder has helped someone feel safer, more controlled, less emotionally overwhelmed, or more disconnected from difficult experiences, recovery can involve losing a coping mechanism before someone feels confident that they have alternatives.
This can create significant ambivalence.
Part of you may desperately want freedom from the eating disorder.
Another part may wonder:
What happens if I don't have this anymore?
That question deserves more than “Just use healthier coping skills.”
Treatment may need to help someone understand what the eating disorder has been accomplishing and develop other ways of meeting those needs.
Trauma Can Change the Relationship With the Body
Eating disorder treatment often asks people to become more connected to their bodies.
For someone with a trauma history, that isn't always straightforward.
Being aware of physical sensations may feel uncomfortable or unsafe.
Changes in body shape or weight may trigger unexpected emotions.
Being seen by other people may feel threatening.
Certain medical examinations, weighing practices, physical touch, or discussions about the body can also be difficult.
A trauma-informed approach recognizes that these reactions may have meaning.
The goal isn't to avoid every uncomfortable experience indefinitely. It's to approach treatment in a way that understands why certain experiences may feel threatening and builds enough safety to work with them.
Control Can Become Complicated
Eating disorders are frequently described as being “about control.”
That explanation can be overly simplistic, but control can play an important role for some people.
Trauma often involves experiences in which someone's control, choice, predictability, or sense of safety was disrupted.
Food, exercise, weight, or routines may later become areas where control feels possible.
This can make highly rigid treatment environments particularly complicated.
Structure can be necessary—and at times lifesaving—in eating disorder care.
But whenever possible, treatment can also preserve opportunities for collaboration, informed choice, and autonomy.
Structure and autonomy don't have to be opposites.
Do I Have to Process My Trauma to Recover From My Eating Disorder?
Not necessarily.
Trauma treatment and eating disorder treatment don't always need to happen simultaneously.
Sometimes the immediate priority is medical stabilization, adequate nutrition, or reducing dangerous eating disorder behaviors.
For other people, avoiding trauma entirely can eventually limit progress because trauma-related symptoms continue to influence eating disorder behaviors.
Treatment therefore needs to consider timing, stability, readiness, and the individual's goals.
There is no rule that says someone must tell their entire trauma story before they can recover from an eating disorder.
And trauma treatment shouldn't automatically be introduced simply because someone has experienced trauma.
The question is whether trauma-related symptoms are currently affecting the person's life and eating disorder—and whether addressing them is appropriate at this stage of treatment.
Can Trauma-Focused Therapy Be Part of Eating Disorder Treatment?
Yes, for some individuals.
Historically, people with eating disorders and trauma have sometimes received treatment sequentially: stabilize the eating disorder first and address trauma much later.
There are certainly situations where stabilization needs to take priority.
But treatment doesn't always have to conceptualize the eating disorder and trauma as completely separate problems.
When someone is medically and psychiatrically appropriate for outpatient trauma work, trauma-focused interventions may sometimes be incorporated into a broader eating disorder treatment plan.
The specific approach should depend on the individual rather than assuming one trauma treatment is appropriate for everyone.
What Is Accelerated Resolution Therapy (ART)?
One trauma-focused approach that may be incorporated into treatment when clinically appropriate is Accelerated Resolution Therapy, or ART.
ART is a structured psychotherapy that uses imagery and sets of eye movements while a person works with distressing memories, emotions, and physical sensations.
Importantly, ART does not require someone to provide a detailed verbal account of everything that happened to them.
For some people, that can make trauma-focused work feel more approachable.
During ART, the goal isn't to erase the factual memory of an experience. Rather, treatment works toward changing the distressing emotional and physiological responses that have become associated with that memory.
How Might ART Fit Into Eating Disorder Treatment?
ART isn't a treatment for every eating disorder, nor does having an eating disorder automatically mean someone needs trauma therapy.
But for some individuals, eating disorder symptoms may be connected to traumatic experiences or trauma-related beliefs and responses.
For example, someone may experience intense distress related to:
Experiences within or changes to their body
Feeling visible or being perceived by others
Shame associated with the body or eating
Past interpersonal or traumatic experiences
Specific memories connected to food, weight, or treatment
A persistent sense of danger or lack of safety
When those experiences continue to activate significant distress, trauma-focused treatment such as ART may become one component of a larger treatment plan.
The goal isn't simply to “process the trauma so the eating disorder goes away.”
Eating disorders are more complicated than that.
Instead, trauma work may help reduce one of the factors that continues to make eating disorder behaviors feel necessary or difficult to change.
Timing Matters
Being able to offer trauma treatment doesn't mean it should always happen immediately.
Before incorporating ART or another trauma-focused intervention, treatment needs to consider medical and psychiatric stability, current eating disorder behaviors, available coping resources, the person's goals, and whether outpatient treatment remains appropriate.
Sometimes trauma work makes sense now.
Sometimes it makes sense later.
And sometimes another treatment approach is more appropriate.
Individualized treatment means being willing to make that distinction.
What If I Don't Think My Trauma Was “Bad Enough”?
People often minimize trauma in much the same way they minimize eating disorders.
Other people had it worse.
It wasn't really trauma.
I should be over it.
Nothing that terrible happened.
Trauma isn't a competition.
At the same time, therapy doesn't need to label every difficult life experience as traumatic.
A more useful question may be whether an experience continues to influence how you relate to yourself, your body, other people, food, or safety.
If it does, it may be worth understanding.
Trauma Isn't Always the Explanation
There is an opposite mistake clinicians can make too.
Once trauma is identified, it can become tempting to explain every eating disorder behavior through that lens.
But eating disorders are complex.
Biology, genetics, temperament, anxiety, OCD, perfectionism, ADHD, cultural pressures, weight stigma, relationships, dieting, athletic environments, and many other factors can contribute.
Trauma may be one part of someone's story without being the entire story.
Individualized treatment means resisting the urge to force every person into the same explanation.
Recovery May Mean Building Something, Not Just Removing Something
When an eating disorder has functioned as a way to cope, treatment can't focus exclusively on taking behaviors away.
We also need to ask:
What needs to exist in their place?
More emotional regulation?
A greater sense of safety?
Stronger boundaries?
More meaningful relationships?
A different relationship with the body?
More tolerance for uncertainty or distress?
Greater autonomy?
Recovery can involve building a life in which the eating disorder no longer has to perform as many jobs.
For people whose eating disorders and trauma have become intertwined, addressing both may help treatment move beyond simply asking someone to stop a behavior—and toward understanding what has made that behavior so difficult to leave behind.
Trauma-Informed Eating Disorder Treatment in Westport, Connecticut
Dr. Joy Zelikovsky provides individualized, trauma-informed outpatient eating disorder treatment at Shoreline Eating Disorder Center in Westport, Connecticut.
Dr. Zelikovsky is trained in Accelerated Resolution Therapy (ART) and may incorporate ART into eating disorder treatment when trauma-focused work is clinically appropriate. Treatment considers eating disorder symptoms alongside the experiences, relationships, emotions, co-occurring concerns, and trauma-related responses that may influence them.
When appropriate, care is coordinated with registered dietitians, medical providers, psychiatrists, and other members of the treatment team.
In-person treatment is available in Westport, with telehealth available for appropriate clients throughout Connecticut.
A complimentary 15-minute consultation is available to discuss your needs, previous treatment experiences, and whether Shoreline may be a good fit.
This article is for educational purposes and is not intended to diagnose an eating disorder or trauma-related disorder or replace individualized medical, nutritional, or mental health care.
